Inter-uterine Insemination

The medicated aspect of the cycle refers to medications given to me to essentially help me grow one, but no more than two, really great follicles.  These meds are what are referred to as a stimulating medication.

 

Perhaps the easiest way to explain what I had to do is to first describe a normal cycle for a normal fertile couple.  I apologize for taking you back to grade 6 here, however, I have learned more about my reproductive organs on this journey than I ever believed possible.  Remember- I chose labour studies (a social science!), not actual science.

 

So here is goes: 

 

Very basic… NORMAL CYCLE

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The Menstrual Cycle

 

 

Day 1 is the 1st day of your period.  Your estrogen starts to climb and follicles (inside your uterus carrying eggs) start to increase in size.  Eventually, one follicle takes the lead and starts to grow.  Inside the follicle, your egg is maturing.  Once the follicle is approximately 18-22mm your body gets a shot of Luteinizing Hormone.  This causes the follicle bursts and the egg shoots out.  This is called ovulation. 

 

During this time, the estrogen that is increasing creates your uterus to make a nice thick lining for a potential baby to stick and grow.

 

Once the egg is released, it hopefully travels down your fallopian tubes and meets up with some extra strong swimming sperm.  The egg and sperm meet, and fertilize, and they continue to grow.  Your body is now producing progesterone (another hormone) to support the little embryo (fertilized egg).  It travels into the uterine cavity, where hopefully it sticks.  Once it sticks, it wiggles its way into the endometrium (uterine wall).  This is called implantation.  Then, a baby grows!

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Perhaps a tad more scientific… 

 

So for us, the purpose of being on stimulating hormones was to ensure that I grow a good quality follicle and ovulate.  Due to my random periods and problematic bleeding, the clinic chose to assume that I was having issues ovulating on my own.  Then, once the follicle was grown and ready to ovulate, I would be given another medication to ensure the egg gets expelled from my uterus towards my fallopian tubes.  Thirty-six hours after taking that drug, I would be at the clinic receiving Dan’s sperm via a catheter into the top of my uterus.  This is where it was to meet my super egg that I grew and ta-da(!!) A baby would grow!

 

So here we go- the day I had been waiting for was finally here.  We went to the clinic in the afternoon and had an ultrasound to get a baseline reading, and then met with our RE.  He said everything looked great and he said we could start… today!  I’m not entirely sure what I had expected, or when I expected to start, but starting this second was even better than I imagined. 

 

The doc moved on and the nurse came into the room to show me how I would administer the medications.  Having my employment information in my file, I believe that the nurses may have believed I was a nurse… not someone who worked for nurses.  Anyhow, I got literally a 30 second intro to jabbing myself with a needle. 

 

Step 1: Insert cartridge of medication into needle thingy

 

Step 2: Clean the top of the needle thingy with an alcohol swab, then place the individually wrapped needle on the top of the contraption.  Screw on.  Take off needle cap.

 

Step 3: Tap vial to ensure air bubbles move to the top, then push one unit of medicine out the top to ensure air bubbles escape.

 

Step 4: Dial the correct amount of medication.  Jab needle into your belly (cue grabbing a good handful of chubbiness), push down the button to push in the meds, wait 10 seconds, extract.  Properly dispose of needle stuff.

 

 

Okay, I can do this.  A needle once a day for approx. 10-12 days, then we’re all set to get pregnant.  The clinic went through timing with us.  Essentially, after 4 days of medication, I am to come into the clinic every other morning for them to do blood work and a transvaginal ultrasound to monitor the growth of my follicles and track my estrogen levels in my blood.  These would be called ‘monitoring’ appointments.  All monitoring apts were between 0730 – 0930.  Once my estrogen levels are at a high enough level, and the follicle I’m growing is big enough (around 20mm), they would give me another needle to make me ovulate.  An average length of time it takes to grow a follicle to its perfect plumpness and size is about 10-12 days.

 

With this ovulation injection, timing is everything.  You are to inject yourself with the medication, then exactly 36 hours later, the clinic would be inserting the catheter filled with Dan’s sperm into my uterus.

 

The clinic noted a couple of side points that drastically limit your ability to have a life.  The first thing is that the medication must be refrigerated.  The second is that you need to inject yourself at the same time each evening (within 30 minutes either way of your ‘set’ time). 

 

Cycle Day 1: Our good friends just moved back into Hamilton.  Dan and I were invited to go over for dinner and to check out their new place.  Little did I know this would be my first day of medication….  Not wanting to cancel, we came up with a plan.  I have a little ice pack that I use for injuries that has a tensor wrap in it.  We wrapped the medication/needle package in my to go ice pack, and headed to our friend’s house toting the instructions for injection in my purse.

 

We had decided to share our journey with our close family and friends, so this wasn’t a secret.  I tried to concentrate on the conversation during the beginning of the evening, but spent my time either staring at Lacey’s big baby bump, or dreading the needle I’d be jabbing into myself for the 1st time.  I was definitely jealous of Lacey at this point… however, perhaps more interested.  Because, of course, I’d be pregnant in a few short weeks, so she could coach me along!

 

7:00pm hit and it was time.  Trying my best to act non-chalant, I got the needle out and started the prep work.  My heart at this point was pounding… I’m not a nurse, I don’t think I should be jabbing needles into anyone!

 

The biggest hurdle was that the needle was supposed to be going into my belly… except I have giant boobs, so I can’t exactly see my own belly!  So to the mirror I went and counted to 3.  1…2…3… jab.  Ok it hurt.  A tad.  But I think my mind made it worse than anything. 

 

I gave myself my shot, took it out, then let my breath out.  I was alive, I felt a tad weird, but probably from being all worked up.  Because of my bleeding disorder, the little poke was bleeding, but I just kept pressure on it for a couple minutes so it didn’t soak through my shirt.

 

I did it.  Only 5 more days to go until I head back to the clinic to find out how my follicles are growing!

 

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Puregon Pen- The daily injections I was giving myself

 

 

The next couple days of needles went well.  It was becoming easier each time.  The clinic warned me about side effects (read: hormonal crazy woman), but thus far I was doing great.  Dan, who is terrified of needles, was even stabbing me with a needle every now and then.  Every night at 7:00pm, it became like a dance.  I had my parts, Dan had his.  He would get the needle ready and mark on the chart how much medicine I was giving myself, and how much was left in the cartridge.  I jabbed myself, then on we went with our evening.

 

After 5 days I had my very first monitoring appointment.  I walked into the clinic around 8am (so I could make it before work) and was ushered back to the ‘Glass Box’.  The glass box was the internal waiting room for the women doing there monitoring.  I sat down and waited until the lab tech called me across the hall to get my blood work.  Not so bad.

 

Back into the glass box I went to wait for the next call.  This time, another technician took me back into one of the ultrasound rooms.  She told me to undress, gave me my sheet, and said she’d be back.

 

I hopped on the table, figured everything out, and lay there listening to the terrible music playing in the room.  The tech entered, did the transvaginal ultrasound and made some polite conversation about the weather.  What else are you supposed to talk about?  “Hi there, how’s my uterus today?”…

 

Once she was done, she said nothing about my results, and said to get dressed then pop into one of the clinical rooms.  There are 4 rooms, each labeled by a number.  This is where they herd us to get our results. 

 

I sat in the room, next to computer and waited for what was to happen next.  A nurse came in first and opened up my chart on the computer.  I had no idea how to read the chart with various numbers plugged in.  She was kind enough to show me what they were looking at for each appointment.  Two main things mattered: 1) The size and number of the follicles in my ovaries and 2) my estrogen level in my blood work.  The clinic didn’t get my blood results back until around noon each day, so to start, we just looked at my follicles.  I had several in and around 10 mm.

 

I was excited as one was at 11mm.  I thought this was great as it proved that this was working, right?  The nurse said she’d like to see more growth in 5 days, but went to get the RE.  The docs rotate through monitoring appointments and each take a day. 

 

The RE that came in I had not met yet.  She wasn’t happy with the level of growth and increased my medication dosage by a couple of units.  She felt this would help getting things started.

 

Off I went with a prescription for more medication. I started on 50 units and was jumping up to 57 units.  I was going to be pregnant any day now! 

 

I called Dan first as soon as I got in the car.  I told him the scoop and he was just as happy as I.  Next I called my sister Amy.  Amy, being Amy, decided she was going to name this little follicle ‘squirt’.  He was still small she said, but he was a keeper.

 

I had to laugh, perhaps this fertility business wasn’t all bad.

 

Cycle Day 7: My next monitoring appointment was 2 mornings later.  I would be monitored every other day until my follicles reached around 18 or so.  Then I’d have to monitored more closely.  The drive to the clinic was about 40 minutes… Not the most fun thing to do each morning, but I was already on cycle day 7- only about 5 more days to go. Blood work- check.  Transvaginal ultrasound- check.

 

After my tests, another RE came in to give me my results. The 11mm follicle had disappeared, and we had a couple around 10mm still.  Not good… nothing was growing.  I was worried about the disappearing ‘squirt’, but she explained that that follicle probably was not actually the ‘one’ that would take the lead and start growing, it was probably just a tad bigger than the rest.  Feeling a bit more reassured, I asked if she was going to increase my medication again.  She said that they always like to keep you on the same dose for 4 days, as sometimes it takes about that amount of time to see results.

 

The danger of increasing the dosage too quickly was that it could produce multiple follicles.  Multiple follicles meant multiple eggs, which in turn, meant multiple children.  In Canada, clinics are much more conservative so we don’t end up with any more octo-moms.  At my clinic, the most follicles they would allow in one IUI cycle is 2.  Any more, and they would cancel the cycle.  In fact, they boast a 0% rate of triplets for the past several years. 

 

Feeling frustrated, I called Dan with the news and continued on with my day. 

 

Cycle Day 9: Blood work.  Transvaginal ultrasound… Still nothing had happened!  The RE said she’d call me when my bloodwork came back to decide how much to increase my medication.  At noon, they called and said to increase my medication to 75 units of Puregon.

 

Cycle Day 11: Blood work.  Transvaginal ultrasound.  At this point, I’m basically supposed to be ready for a transfer.  But I went back to the clinic hopeful that this new dose would mean a nice big follicle.  I can never read the tech’s faces when they do the ultrasound… They won’t tell you a thing until you get into one of those clinical rooms.  Secretly evil…   I get into the room to find out, again, nothing has happened.  All my follicles are around 10mm.  No growth at all.

 

As I’m obviously looking quite upset, the RE tries to calm me down and says not to fret, some people just take longer than others.  We will get it sorted out!

 

Cycle Day 13: Blood work.  Transvaginal Ultrasound. Still nothing.  But no medication increases… stupid 4 day rule!

 

Cycle Day 15: Blood Work.  Transvaginal ultrasound.  Still nothing…. Can this really be happening?  This was supposed to be easy.  PLUS, I’m not here because I have a fertility issue, I’m here because of my bleeding disorder.  At least they increase the meds today!

 

Cycle Day 17: Blood work.  Transvaginal ultrasound.          Nothing. At all. 

 

By now, my arms look like I’m a serious drug user from all the blood work, and my belly is a patchwork of black and blue bruises.  Putting on pants is the most frustrating part of my day because I’m both bloated and the waist kills against my bruised stomach. 

 

My RE is on today and asks the tech to re-do my ultrasound so he can take a look.  After seeing my scans, he announces that he believes I have PCOS- Polycystic Ovarian Syndrome.  More on this later, but basically, I have lots of follicles, but none will grow.  He saw a bit of this in my initial scans, but the new scans together with my follicles that won’t grow meant for sure, PCOS.  Again, he increases my meds.  I’m now sitting around about 100 units a day.  The more medication you take, the more emotional you are.  Wonderful… Poor Daniel.  In addition, I’m becoming very sensitive to the touch, my abdomen is killing and I’m having massive headaches from the meds.  My body feels like I have the flu.  Everything is aching. 

 

Daniel, trying to stay positive, starts joking with me by listing all the body parts that don’t hurt.  “Does your hair hurt?”  “How about your finger nails?” …Yes Dan, I guess it could be worse! 🙂

 

On we go.

 

 

 

By now, it’s incredible how fertility takes over your life. My days would be something like this:

 

Clinic Day:

 

Wake up extra early, head to the clinic for your blood work and transvaginal ultrasound.  Get ultrasound results from clinic then head to work. My results would suck so I’d need to stop crying by the time I’d hit a certain spot on the road so my face wouldn’t be too blotchy when I showed up at work. 

 

Around noon, you would get a call from the nurse at the clinic reporting my blood work.  Again, bad news.  I’d close my office door, call Dan to report the latest numbers.  Crying wasn’t an option in my office so I’d try to keep it together.  Then back to work. 

 

I would be so upset from the lack of growth, that I would spend hours sulking around and faking smiley around my colleagues.  Faking happy was taking as much energy as jabbing myself with needles each night!  After work, I’d get home and watch the clock tick until it hits 7:00pm, then give myself the medicine. 

 

I’d be really down, and by this point, the hormones were kicking my butt.  I was so weepy that watching an episode of Grey’s Anatomy would be enough to make me bawl for hours.  Dan, being the most amazing guy, wouldn’t bat an eye and console me and continue with his never ending positive words.  Some days I just wanted to hit him- how could be always be SO positive!?

 

Day After Clinic Day:

 

Ok time to make myself get out of this slump.  They increased my medication, so this is going to work now.  So what it’s taking longer than they thought… good things come to those who wait, right?  I’d spend most of the day talking myself into good and positive thoughts.  This was going to work!  Think big picture- the end result would be more than worth this!

 

Clinic Day again…:

 

Blood work.  Transvaginal ultrasound.  Head back to the clinic for more bad news.  The roller coaster of emotion was to start again.

 

 

 

Cycle Days 19-29:  Blood work.  Transvaginal ultrasound.  Nothing changes.  No growth.  Now the RE’s are concerned.  I’m on high dosages of medication (similar to those who are double my age) and it still isn’t working. 

 

The RE’s at the clinic actually have a meeting about me to try and figure out ideas- they just don’t know how to explain what is going on.  They come up with another idea, they are going to add in a second medication to try and get things going.  It’s now mid-March, and I’m a emotional nightmare.  Another needle, sure I can do that.  More hormones, wonderful. 

 

Now on about 150 units of Puregon and a microdose of HcG.  Two needles a night now at 7pm and heading into the clinic every other day is certainly taking it’s toll!

 

Cycle Days 31-37:  I still have not one follicle over 11mm.  Really?  What is wrong with me?  Even the docs don’t know how to explain this!    If I make it to cycle day number 39, then it’s officially a new record for the clinic- longest cycle ever.  Wonderful… I’m breaking records for having useless ovaries.

 

Dan came into the last appointment with me so we could discuss options with the RE.  The RE is now suggesting that we just cancel this cycle and try again after I take a break.  Most people don’t make it to Cycle Day 20 because of the time, money, and hormones.  Did I need a break?  Hell yes, but wasn’t cancelling the cycle giving up?  We decided we’d give it 2 more days, then, if there was nothing still, we’d call it quits.

 

Cycle Day 39: Blood work.  Transvaginal ultrasound.  It’s like us threatening to give up gave my ovaries a kick in the pants.  We finally had growth!!!!!  I have one follicle at 16mm- it was growing and my blood work was rising as it should be.  I’m beyond ecstatic.  I call Dan, my parents, my sister, my sister-in-law, and Janica- my best friend.  I’m practically crying (happy tears this time!) just trying to share the news- we have a good and growing follicle!  Amy is sure that this is ‘Squirt’ rejoining the game so it looks like this follie has a name!

 

As the cycle days continue, I’m going into the clinic each day now for monitoring appointments.  By Cycle Day 45 we are ready to go!  We actually have one follicle at 19mm, and another following behind at 16mm.  The clinic is nervous if we wait much longer, I may grow more and we may need to cancel the cycle due to too many follicles.  It’s time- I get instructions on how to give myself the needle to make me ovulate.  April 4th is going to be our IUI!!!!!

 

 

April 4th: Here we go- it’s a gorgeous day out and I’m joking with Dan that today seems to be a great day to get pregnant.  Lord knows I’ve now been through hell for a month and a half straight (and Dan has put up with me for that many).

 

The first step is for Dan to produce a sperm sample in the morning, and make our quick drive to the clinic to make it within the 30 minute window.  Dan had to explain to his work what was going on so he could get the day off with little notice.  Off we drove, again, with our sperm sample under my armpit for warmth.

 

We dropped it off at the clinic as they needed to do a ‘sperm wash’.  Insert joke here… trust me, I think we’ve thought of them all!  No, he doesn’t have dirty sperm (well at least so the docs say!).  Basically, they separate the seminal fluids from the sperm.  We just want the swimmers.

 

Dan and I head out for breakfast while the lab does their thing.  We found a great breakfast place and enjoyed a relaxing morning together.  Target had just opened in Canada so we decided to take a peak.  We walked by the baby aisles and I was secretly dreaming about the boy or girl that was about to be.  I actually stopped at the newborn clothes… Dan grabbed my arm and said perhaps we should wait on that type of shopping.  :S

 

11am- We went back to the clinic and waited to be called.  We were placed in a clinical room and I got undressed from the waist down and on the table.  The RE entered and gave us the results of the sperm sample.  The numbers were fantastic as was the quality.  Dan and I actually gave each other high fives- awesome sperm!  We had to sign off on the paper work that the sample was ours, and then sign off consent for the procedure.

 

The RE put a catheter up into my uterus- not so bad, just a bit of a pinch.  Then, the doc pushed the vial of sperm through the catheter into the top of my uterus.  I even made an IUI playlist on Dan’s iPhone so the swimmers had good beats to swim to (Dallas Green, Taylor Swift, and Carly Rae Jepson!).  It was over in less than 5 minutes.  She told me to relax for a couple minutes, then head home and spend the day there resting.

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Inter-uterine Insemination (IUI)

 

 

Five minutes later, I was off into the car.  I laid in the back seat of the car with my knees up hoping that gravity wouldn’t work against us.  This day took me 45 days to get to- not 11 to 13 like they estimated- and damn it, it was going to work.  I spent the rest of the day at home on the couch with my feet straight in the air.   I was actually nervous to pee… illogical I realize, but what if we lost them all!

 

Now the next big dilemma- when could I consider myself pregnant?  The egg had to have met the sperm by now.  Look out, I was almost ready to park in the expectant mother’s parking spot!

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2 thoughts on “Inter-uterine Insemination

  1. seriously well written! Do you find that all you see are pregnancy test commercials? I will curse them everytime i see them for you (and I!)

  2. Thank u so much for this blog! I just had my 2nd iui today , your descriptions of this whole experience are so honest and exact and I’m glad I’m not the only one with all these thoughts and crazy emotions .

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